C型骨盆骨折患者内固定术后下肢深静脉血栓形成危险因素分析及相关列线图模型的构建

Analysis of risk factors for lower extremity deep venous thrombosis in patients with type C pelvic fracture patients after internal fixation and construction of related nomogram model

目的探讨C型骨盆骨折患者内固定术后下肢深静脉血栓(DVT)形成的危险因素,并建立相关列线图模型。方法纳入2018年1月至2022年1月就诊于该院骨科中心的217例C型骨盆骨折患者作为研究对象,均接受内固定手术治疗,根据术后是否形成DVT分为DVT组和非DVT(N-DVT)组,比较2组一般临床资料和术前炎症因子表达水平,多因素分析获得影响C型骨盆骨折患者内固定术后DVT形成的独立预测因素,重点分析术前炎症因子与C型骨盆骨折患者内固定术后DVT形成的相关性,构建相关列线图模型,以Bootstrap法和校准曲线进行列线图模型的内部验证,绘制预测C型骨盆骨折患者内固定术后DVT形成的ROC曲线和决策曲线,分析独立预测及联合预测的预测效能和净收益率。结果多因素分析结果显示,年龄、糖尿病、术前肿瘤坏死因子-α(TNF-α)、牵引制动及卧床时间是影响C型骨盆骨折患者内固定术后DVT形成的独立预测因素(P<0.05),基于独立预测因素构建预测C型骨盆骨折患者内固定术后DVT形成的列线图模型;列线图模型的区分度评价指标C指数为0.834(95%CI:0.812~0.924);拟合优度(H-L)检验结果显示:C型骨盆骨折患者内固定术后DVT形成概率的预测值与实际观测值符合度良好(P>0.05);ROC曲线分析和决策曲线分析显示:年龄、糖尿病、TNF-α、牵引制动、卧床时间及联合预测模型预测C型骨盆骨折患者内固定术后DVT形成均具有良好的预测效能和净收益率。结论年龄、糖尿病、TNF-α、牵引制动及卧床时间为影响C型骨盆骨折患者内固定术后DVT形成的独立预测因素,基于以上独立预测因素构建的列线图模型预测C型骨盆骨折患者内固定术后DVT形成具有较高的价值。

Objective To investigate the risk factors of lower extremity deep venous thrombosis(DVT)after internal fixation in patients with type C pelvic fracture,and to establish a relevent nomogram model.Methods Atotal of 217 patients with type C pelvic fractures who were admitted to the Orthopedic Center of the hospital from January 2018 to January 2022 were included in the study.All patients underwent internal fixation.According to whether DVT of the lower extremities was formed after operation,they were divided into the DVT group and the non-DVT group(N-DVT).The general clinical data and preoperative inflammatory factor expression levels of the two groups was compared.Multivariate analysis was used to obtain independent predictors of DVT formation after internal fixation in patients with type C pelvic fractures.The correlation between preoperative inflammatory factors and DVT formation after internal fixation in patients with type C pelvic fractures was analyzed.The relevant nomograph model was constructed,and the Bootstrap method and calibration curve were used to verify the nomograph model internally.The ROC curve and decision curve for predicting DVT formation after internal fixation in patients with type C pelvic fracture were drawn,and the predictive efficiency and net rate of return of independent prediction and combined prediction were an-alyzed.Results Multivariate analysis showed that age,diabetes,preoperative tumor necrosis factor-α(TNF-α),traction and braking,and bed rest time were independent predictors of DVT formation after internal fixa-tion in patients with type C pelvic fractures(P<0.05).A nomograph model was constructed based on inde-pendent predictors to predict the formation of DVT after internal fixation in patients with type C pelvic frac-ture,and the C index of the distinguishing evaluation index of the nomogram model was 0.834(95%CI:0.812-0.924),the results of goodness of fit(H-L)test showed that the predicted value of DVT formation probability after internal fixation in patients with type C pelvic fracture was in good agreement with the actual observed value(P>0.05).ROC curve analysis and decision curve analysis showed that age,diabetes,TNF-α,traction and braking,bed rest time and combined prediction model had good predictive performance and net yield in predicting DVT formation after internal fixation in patients with type C pelvic fracture.Conclusion Age,diabetes,TNF-α,traction braking and bed rest time are independent predictors of DVT formation after internal fixation in pa-tients with type C pelvic fracture.The nomogram model based on the above independent predictors has a high value in predicting DVT formation after internal fixation in patients with type C pelvic fracture.